Provider Demographics
NPI:1336501436
Name:HOLTS, KALATO LEHUE (FNP)
Entity Type:Individual
Prefix:
First Name:KALATO
Middle Name:LEHUE
Last Name:HOLTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BRADFORD SQ STE A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-1960
Mailing Address - Country:US
Mailing Address - Phone:770-376-6160
Mailing Address - Fax:
Practice Address - Street 1:112 GOVERNORS SQ STE D
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4864
Practice Address - Country:US
Practice Address - Phone:770-892-5083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV826153363L00000X
GARN151100363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily